“Rebound” hypercoagulability after interruption of anticoagulation in patients with atrial fibrillation

Li, Jing; Wang, Xuan; Sun, Min; Yang, Guang

doi:10.1016/j.ijcard.2018.04.123

Cited by 3 publications

(1 citation statement)

References 5 publications

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“…One possibility for the average time to VTE to occur after average medication completion could be due to a rebound hypercoagulable effect. In 2018, Li et al 38 reported that although a rebound effect is controversial, physicians should be aware of the possibility. The mechanism behind this rebound hypercoagulable phenomenon after discontinuation is uncertain.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Different Post-operative Prophylactic Strategies on Symptomatic Venous Thromboembolism after Total Knee Arthroplasty

Wardyn¹,

Chong

Piatt³

2022

kjm

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INTRODUCTION. The objective of this study was to evaluate the use of different postoperative prophylactic strategies on the rates of symptomatic venous thromboembolic events (VTE) incidence after primary total knee arthroplasty (TKA). METHODS. A retrospective study of patients who had undergone primary TKA procedure was performed from January 2015 through July 2020. Outcomes examined prophylaxis medication used during inpatient care and outpatient care, amount of medication, length of medication, complications occurring within 90 days postoperatively, including symptomatic VTE (deep venous thrombosis (DVT) and pulmonary embolism (PE)), gastrointestinal bleeding requiring medical attention, change in management protocols after post-operative complications and mortality. RESULTS. 5,663 cases were included (mean age 66±10years, mean BMI 34.1±7.1kg/m2). The overall post-operative complication rate was 0.9% (DVT: 0.5%, PE: 0.3%, VTE: 0.04%, and GI bleeding: 0.09%). Enoxaparin (Lovenox) use as inpatient anticoagulation medication was significantly reduced (67% vs 13%, p<0.001), and apixaban (Eliquis) was significantly increased (6% vs 49%, p<0.001). Average hospital stays were significantly reduced among the years (3±2days vs 2±1days, p<0.001), and complication rates were not significantly different between the five years (~1%, p<0.001). Most post-operative complications occurred on either aspirin 325mg (36%) or apixaban (26%). However, the relative risk ratio results indicating that utilization of warfarin (Coumadin), rivaroxaban (Xarelto), and aspirin 81 mg as outpatient anticoagulation medication were more likely to increase the risk of symptomatic VTE incidence compared to other anticoagulants. The average time of complication detected was 21±21days (range: 1-87days). >54% of complication events occurred after the patient had completed their medication (enoxaparin, rivaroxaban and apixaban). CONCLUSIONS. The observed incidence of symptomatic VTE in this study is similar to previous studies regardless of the type of postoperative inpatient or outpatient prophylaxis prescribed. The ultimate choice of prophylaxis should remain with the treating physician and their knowledge of a particular patient’s medical history.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Different Post-operative Prophylactic Strategies on Symptomatic Venous Thromboembolism after Total Knee Arthroplasty

Wardyn¹,

Chong

Piatt³

2022

kjm

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Prothrombotic fibrin clot properties are associated with post-discharge venous thromboembolism in acutely ill medical patients

Zaręba

Undas

2019

Thrombosis Research

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The effects of anticoagulant therapy re‐initiation after gastrointestinal bleeding: A systematic review and meta‐analysis

Jingnan

Bao

et al. 2021

J Clin Pharm Ther

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What is known and Objective: Long-term anticoagulant/antithrombotic therapy is widely used for the management of thromboembolic conditions. Gastrointestinal bleeding is a common collateral manifestation of anticoagulant/antithrombotic therapy that complicates its administration. The continuation or discontinuation of anticoagulant/antithrombotic therapy after an episode of gastrointestinal bleeding has been a matter of debate. Despite recent positive reports from retrospective cohort studies suggesting a reduction in morbidity-and mortality-related outcomes with continued administration of anticoagulant/antithrombotic agents (even after gastrointestinal bleeding), no consensus or comparisons about the efficacies of continued or discontinued antithrombotic administration exist. Therefore, we developed this current state-of-evidence analysis evaluating the comparative effects of continuation and discontinuation of anticoagulant/antithrombotic drugs after gastrointestinal bleeding on the overall incidences of gastrointestinal bleeding, thromboembolic events and mortality events. Methods:We performed a systematic academic literature search according to the PRISMA guidelines across five databases: Web of Science, Embase, CENTRAL, Scopus and MEDLINE. Moreover, we conducted a random effect meta-analysis to compare the effects of continuation and discontinuation of anticoagulant/antithrombotic drugs after an event of gastrointestinal bleeding on the overall incidences of gastrointestinal bleeding, thromboembolic events and mortality events. Results:We found seven eligible studies (from 1397 candidates) with 2532 participants (mean age, 73.1 ± 4.1 years). Our meta-analysis revealed lower odds of thromboembolic events (OR, −0.21), mortality outcomes (OR, −0.39) and an increase in the incidence of gastrointestinal bleeding (OR, 2.4) in the group with continued anticoagulant/antithrombotic therapy than in the group discontinuing the therapy. What is new and Conclusion:We provide an updated evidence on the comparative effects between continuation and discontinuation of anticoagulant/antithrombotic drugs after gastrointestinal bleeding events based on the overall incidences of gastrointestinal bleeding, thromboembolic events and mortality events. This study reports confirm an overall lower incidence of thromboembolic events and mortality outcomes for the continuation group than for the discontinuation group.

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“Rebound” hypercoagulability after interruption of anticoagulation in patients with atrial fibrillation

Cited by 3 publications

References 5 publications

Clinical Outcome of Different Post-operative Prophylactic Strategies on Symptomatic Venous Thromboembolism after Total Knee Arthroplasty

Clinical Outcome of Different Post-operative Prophylactic Strategies on Symptomatic Venous Thromboembolism after Total Knee Arthroplasty

Prothrombotic fibrin clot properties are associated with post-discharge venous thromboembolism in acutely ill medical patients

The effects of anticoagulant therapy re‐initiation after gastrointestinal bleeding: A systematic review and meta‐analysis

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